What is the assessment and plan for hip bursitis?

Assessment and Plan for Hip Bursitis

The management of hip bursitis should include a comprehensive biopsychosocial approach with individualized non-pharmacological interventions as the cornerstone of treatment, supplemented by appropriate pharmacological management when necessary. 1

Initial Assessment

• Perform a thorough biopsychosocial assessment including:

  • Physical status evaluation (pain, fatigue, sleep quality, joint status, mobility, strength, posture, comorbidities, weight) 2
  • Activities of daily living assessment 2
  • Participation evaluation (work, leisure, social roles) 2
  • Mood assessment 2
  • Health education needs and motivation to self-manage 2

• Evaluate for specific hip bursitis symptoms:

  • Lateral hip pain that may worsen with prolonged standing, walking, or climbing stairs 3
  • Pain when lying on the affected side 3
  • Tenderness over the greater trochanter 3

Non-pharmacological Management

• Exercise therapy:

  • Implement a regular individualized daily exercise regimen focusing on:
    • Strengthening exercises for both legs, particularly quadriceps and proximal hip girdle muscles 2
    • Aerobic activity and exercise 2
    • Range of motion and stretching exercises 2
  • Start with exercises within the patient's capability and gradually increase intensity over several months 2
  • Consider both land-based and aquatic exercises to reduce joint loading while maintaining strength 1

• Activity modification:

  • Implement pacing strategies with "small amounts often" approach 2
  • Link exercise regimens to daily activities to improve adherence 2
  • Avoid activities that exacerbate symptoms 4

• Physical modalities:

  • Apply thermal agents (heat or ice) to reduce pain and inflammation 1
  • Consider intensive pulsed ultrasound therapy for cases with calcifications 5

• Assistive devices:

  • Use walking aids such as a cane on the contralateral side if needed 2
  • Consider appropriate and comfortable footwear to reduce stress on the hip 2

• Weight management:

  • For overweight patients, implement weight loss strategies including:
    • Regular self-monitoring of weight 2
    • Increased physical activity 2
    • Structured meal planning with portion control 1

Pharmacological Management

• First-line medication:

  • Acetaminophen due to its favorable safety profile 1
  • NSAIDs for pain and inflammation control 6

• Second-line options:

  • Intra-bursal corticosteroid injections when oral medications and non-pharmacological approaches fail 1
  • Tramadol may be considered when acetaminophen and NSAIDs are ineffective or contraindicated 1

Self-Management Education

• Provide individualized education about:

  • The nature of hip bursitis, its causes, consequences, and prognosis 2
  • Maintenance and pacing of activity 2
  • Regular exercise regimen importance 2
  • Weight management if applicable 2

• Ensure education is:

  • Tailored to the person's illness perceptions and educational capability 2
  • Reinforced at subsequent clinical encounters 2
  • Supported by written or other types of information 2
  • Inclusive of partners or caregivers when appropriate 2

Follow-up and Monitoring

• Establish short-term and long-term goals 2
• Develop action plans with regular evaluation and follow-up 2
• Adjust the program as needed based on response 2

Refractory Cases

• For persistent symptoms despite conservative management:
  • Consider referral for specialist evaluation 6
  • Surgical intervention (trochanteric bursectomy) may be required for recalcitrant cases 7
  • Minimally invasive arthroscopic techniques are available for persistent cases 7

Common Pitfalls to Avoid

• Relying solely on medications without implementing exercise and weight management strategies 1
• Using glucosamine or chondroitin supplements, which are not recommended 1
• Failing to provide adequate education about the condition and self-management 1
• Neglecting to address psychological aspects of chronic pain 2